Remote Utilization Review RN 9-Month Contract (TX/IL)

hireops; Chicago (IL); Remote; USD 73,800 - 90,200; Full time

Job summary

hireops is seeking a Registered Nurse (RN) for a contract position lasting approximately 9 months. Remote work is available, but candidates must reside in Texas or Illinois. The job involves validating medical necessity, reviewing claims, and communicating with providers and members.

The ideal candidate will have an unrestricted RN license, at least 3 years of clinical experience, and knowledge of health insurance legislation and accreditation standards.

Qualifications

• Registered Nurse (RN) with an unrestricted license in Texas or Illinois.
• 3 years of clinical experience required.
• Knowledge of accreditation standards (URAC, NCQA) is essential.

Responsibilities

• Validate medical necessity and appropriateness of treatment plans.
• Perform medical review of claims suspended for medical criteria.
• Respond to correspondence from providers or members regarding medical decisions.

Skills

Clinical experience

Verbal communication

Organizational skills

Proficiency in Microsoft Word

Proficiency in Microsoft Excel

Education

Registered Nurse (RN) license

Tools

Health insurance databases

Job description

hireops is seeking a Registered Nurse (RN) for a contract position lasting approximately 9 months. Remote work is available, but candidates must reside in Texas or Illinois. The job involves validating medical necessity, reviewing claims, and communicating with providers and members.

The ideal candidate will have an unrestricted RN license, at least 3 years of clinical experience, and knowledge of health insurance legislation and accreditation standards.